Abstract
Background
The National Surgical Quality Improvement Project is the preeminent surgical quality
database, but it undercaptures acute kidney injury. Recently, the National Surgical
Quality Improvement Project lowered the thresholds for acute kidney injury for the
first time, so we assessed the impact of implementing the definition change on the
rate of acute kidney injuries.
Methods
For this interrupted time series analysis, we assembled 2 institutional National Surgical
Quality Improvement Project files to identify adults undergoing inpatient noncardiac
nonvascular surgery. The acute kidney injury definition changed on July 1, 2021, so
patients were stratified by their operative date into 12-month pre and post groups.
Weighted covariate propensity score matching and logistic regression were used to
balance the periods and compare outcomes.
Results
In total, 4,784 adults were eligible (55% pre and 45% post change). The overall rate
of postoperative outcomes was similar, aside for acute kidney injury (pre 0.3%, post
5.6%, P < .0001). Regardless of the period, patients with acute kidney injuries had significantly
longer lengths of stay and morbidity and mortality rates compared to those without
an acute kidney injury. After the definition change, 81% of acute kidney injuries
were stage I, and none were identified by urine output alone. After matching, surgery
after the definition change was associated with an increased weighted odds of an acute
kidney injury compared to surgery before the change (odds ratio 26.2; 95% confidence
interval, 12.1–56.8).
Conclusion
In the year after the definition change, there was a 1,700% relative increase in the
rate of reported acute kidney injuries. Newly identified acute kidney injuries are
associated with high complication rates, and this definition change has implications
for patient counseling, research, and quality reporting.
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Article info
Publication history
Published online: January 06, 2023
Accepted:
November 23,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
